24 WEATHERLY DRIVE_ CLAIM 7.10.22 THENORFOLKf DEDHAMGROUN
Norfolk&Dedham Mutual Fire Insurance Co. Dorchester Mutual Insurance Co. Fitchburg Mutual Insurance Co.
July 19, 2022
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B
Building Commissioner, or Inspector of Buildings
c/o City or Town Hall
93 Washington St.
Salem, MA 01970
Board of Health or Board of Selectmen
c/o City or Town Hall
93 Washington St.
Salem, MA 01970
Fire Department or Arson Squad
c/o City or Town Hall
93 Washington St.
Salem, MA 01970
RE: Our File No.: P2299646
Insured: MARILYN COSTA
24 WEATHERLY DRIVE
Address: 2, SALEM, MA
Policy No.: H1824192A
Loss Date: 07/10/2022
Loss Type: Building or Other Structure Damage
A claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be
applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct
it to my attention and include a reference to the captioned insured, location policy number, loss
date and claim or file number.
If no reply is received from your office within ten days, we will assume you have no liens of any
type against this property, and the claim will be paid in our customary manner.
Sincerely,
JUL --u4;
Bonnie L. Purcell JUL
Sr. Property Claim Adjuster
1-800-688-1825 x1708 w Mid-Atlantic
Home Office400
222 Ames Street,P.O.Box 9109 50 Division Street,Suite NJ 876
Dedham,MA 0202T9109 SINCE 1825 Somerville,
Phone:(800)688.1825 www.ndgroup.com
.com